NURS 680B Week 2 Discussion Advanced Health/Physical Assessment

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, choice #2 19-year old male.

A 50-year old female complains of being waken up at night with a bitter taste in her mouth about four times per week for the past two months. It is interfering with her sleep and she is concerned.

A 48-year old male complains of severe epigastric pain that is worse after eating x 3 weeks. Symptoms are accompanied by nausea but patient denies vomiting or diarrhea at this time. Reports stools as “normal” in color and consistency.

A 22-year old female complains of 3 days of watery diarrhea with 7-8 stools per day. She is drinking approx. “3 sodas a day” because she is “trying to not get dehydrated”. Very little other intake because “eating makes me have to go to the bathroom”.

NURS 680B Week 2 Discussion Advanced Health/Physical Assessment

For the case you have chosen, post to the discussion:

Discuss what questions you would ask the patient, what physical exam elements you would include, and what further testing you would want to have performed.

In SOAP format, list:

Pertinent positive and negative information

Differential and working diagnosis

Treatment plan, including: pharmacotherapy with complementary and OTC therapy, diagnostics (labs and testing), health education and lifestyle changes, age-appropriate preventive care, and follow-up to this visit.

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

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In your peer replies, please reply to at least one peer who chose a different case study.

Vomiting and diarrhea occur together
Vomiting is the forceful emptying (throwing up) of what is in the stomach
It’s normal for nausea (upset stomach) to come before each bout of vomiting
Diarrhea means 3 or more watery or very loose stools. Reason: 1 or 2 loose stools can be normal with changes in diet.
If vomiting is done, use the Diarrhea care guide.

Causes of Vomiting with Diarrhea

Viral Gastroenteritis. GI infection from a virus is the most common cause. A common agent is the Rotavirus. The illness starts with vomiting. Watery loose stools follow within 12-24 hours. On cruise ship outbreaks, the most common viral cause is Norovirus.
Food Poisoning. This causes rapid vomiting and diarrhea within hours after eating the bad food. Caused by toxins from germs growing in foods left out too long. An example is Staph toxin in egg salad.
Traveler’s Diarrhea. Caused by germs in food or drink. Suspect this if it follows recent foreign travel.
Bacterial GI Infection. Diarrhea can also be caused by some bacteria. Most bacterial diarrhea goes away on its own. A few can cause a severe large bowel infection (such as Shigella colitis).
Serious Complication: Dehydration. This is the health problem where the body has lost too much fluid. (See below for more on this).

Vomiting Scale

Mild: 1 – 2 times/day
Moderate: 3 – 7 times/day
Severe: Vomits everything, nearly everything or 8 or more times per day
Severity relates even more to how long the vomiting goes on for. At the start of the illness, it’s common to vomit everything. This can last for 3 or 4 hours. Children then often become stable and change to mild vomiting.
The main risk of vomiting is dehydration. Dehydration means the body has lost too much fluid.
Watery stools with vomiting carry the greatest risk for causing dehydration.
The younger the child, the greater the risk for dehydration.

Diarrhea Scale

Mild: 3-5 watery stools per day
Moderate: 6-10 watery stools per day
Severe: Over 10 watery stools per day
The main risk of diarrhea is dehydration.
Frequent, watery stools can cause dehydration.
Loose or runny stools do not cause dehydration.

Dehydration: How to Know

Dehydration means that the body has lost too much fluid. This can happen with vomiting and/or diarrhea. A weight loss of more than 3% is needed. Mild diarrhea or mild vomiting does not cause this. Neither does a small decrease in fluid intake.
Vomiting with watery diarrhea is the most common cause of dehydration.
Dehydration is a reason to see a doctor right away.
These are signs of dehydration:
Decreased urine (no urine in more than 8 hours) happens early in dehydration. So does a dark yellow color. If the urine is light straw colored, your child is not dehydrated.
Dry tongue and inside of the mouth. Dry lips are not helpful.
Dry eyes with decreased or absent tears
In babies, a sunken soft spot
Slow blood refill test: Longer than 2 seconds. First, press on the thumbnail and make it pale. Then let go. Count the seconds it takes for the nail to turn pink again. Ask your doctor to teach you how to do this test.
Fussy, tired out or acting ill. If your child is alert, happy and playful, he or she is not dehydrated.
A child with severe dehydration becomes too weak to stand. They can also be very dizzy when trying to stand.

NURS 680B Week 2 Discussion Advanced Health/Physical Assessment